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# DLA Official Forms

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| Form Number:  DLA7012                                                                                                                                                                                             |
|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Form Title:  Ebola Post-Exposure Symptom Diary                                                                                                                                                                    |
| Form Version:  Canceled                                                                                                                                                                                           |
| Status:  Canceled                                                                                                                                                                                                 |
| Functional Area:  Installation Management                                                                                                                                                                         |
| Opr:  DM                                                                                                                                                                                                          |
| Safeguards:  PAS, PII                                                                                                                                                                                             |
| Electronic:  Yes                                                                                                                                                                                                  |
| Form Link:  |options=W                                                                                                                                                                                            |
| Type:  Primary                                                                                                                                                                                                    |
| Prescribed:  Pre-deployment, Deployment, and Post-deployment Training, Screening, and Monitoring Guidance for Department of Defense Personnel Deployed to Ebola Outbreak Areas. Dated October 10, 2014.           |
| Description:  THIS FORM IS CANCELED AS A RESULT OF THE 2020 FORMS SURVEY ON DLA-LEVEL FORMS.  Form was be used to document the monitoring of symptoms for returning deployed DLA civilian and military personnel. |
| Records Retention:  162.40 Employee Medical File (GRS 1, Item 21)                                                                                                                                                 |
| Form Audience:                                                                                                                                                                                                    |

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